‘Transplantation across Blood –Groups’ – In this method the preformed antibodies are removed by plasmapheresis and special medicines are given to the recipient to prevent antibody formation. Some centres also remove the spleen. The levels of antibodies are monitored in the post transplant period and necessary steps taken to keep them down, to prevent rejection. This form of transplant involves a lot of cost and generally the rates of rejection are high, but with technological improvement, the results are improving.
Post transplant follow –up:It is of utmost importance to know that the recipient has to be on lifelong immunosuppressive medicines (medicines which prevent the rejection of the kidneys). He also has to be under the regular follow up of a nephrologist so that any problem of the transplant kidney can be picked up quickly.
During each visit, the nephrologist monitors the functioning of the transplanted kidney and tries to adjust the dose of immunosuppressive medicines to keep the side-effects of these medicines to a minimum.
He will look for any new-onset infection or a malignancy, which are quite common in these patients. Metabolic complications post transplant, like Diabetes, hypertension, hyperlipidemia , obesity and Coronary artery disease have to be actively searched for, to prevent deaths and morbidity in these patients.
The current recommendations suggest that the patient should visit the nephrologist or the transplant team 2-3 times per week after discharge in the immediate post transplant period. The visit dates are extended gradually if the patient is stable and is expected to come for follow up every month till the first three months. Later they come every 2-3 months or as directed by their doctor.